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TopherTuesdays is a video blog dedicated to empowering others through insurance education. In addition, we share world class interviews exploring personal and professional development, health, fitness, entrepreneurship and education.

Most people would jump at a 7% to 12% reduction in costs for the same product or service. But when that strategy is a partially self-funded medical plan, employers hesitate concerned about their maximum claims liability.

Despite perceived risks – converting from a fully insured to a level or partially self-funded arrangement can be the first step in aggressively managing your overall health care spend. While fully-funded insurance plans are less volatile, the self-funding model is ideal for accessing relevant data and information that can be used to make informed and intelligent cost management decisions.

For organizations with 100 employees or more typical net savings include:

  • 2.5% of premium for avoiding taxes (depending on state)
  • 5.0% of premium avoidance of carrier margin (profit)
  • 2.5% avoidance of ACA pass through taxes (in 2014 and later)
Currently, more than 90 million employees get health insurance through self-funded plans as employers realize the cost savings, plan flexibility and employee satisfaction that can manifest as earlier as one year after implementation. A self-funded insurance plan can include medical, dental, vision, prescription medications and workers’ compensation. #TopherTuesdays

You pour your heart into your career. The future is bright and you plan to grow at your company. Suddenly, things change when your spouse is diagnosed with a terminal illness. Family is the top priority but you fear losing your job and “organizational favor” if you take time off.

Fortunately under the Family and Medical Leave Act (FMLA), eligible employees may take up to 12 weeks of unpaid leave from their covered employer to take care of a close family member who has a serious health condition, for the birth or adoption of a child, or for the employee’s own emergency medical care. FMLA also requires that group health benefits be maintained for the employee during their job-protected leave.

It is unlawful for any employer to interfere with, restrain, or deny the exercise of any right provided by the FMLA. Additionally, it’s unlawful for an employer to retaliate or discriminate against any individual who has used Family & Medical Leave.

Employers generally find the FMLA simpler on its face than it actually is in practice. In reality, a large number of organizations are unwittingly not in compliance with the FMLA. Check with your manager or Human Resources department for your company’s policies on other forms of leave.

More than likely, your fastest growing household or business expense is the cost of prescription drugs.

In my first video blog, I sat with Mark Haye to briefly discuss the national pharmacy spend crisis.

A few takeaways:
1. High cost drugs are driving up overall healthcare spending
2. Employers should examine their pharmacy benefit contract agreements to uncover rebates and commissions that may create misaligned incentives
3. Educate yourself on therapeutically similar alternatives that are less expensive to meet your pharmacy needs

Stay tuned for new and improved content dedicated to empowering others through insurance and healthcare education. #TopherTuesdays


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You’re a single parent and hourly worker. Your child needs a prescription for a basic infection but you cannot afford to take the day off for a doctors’ appointment. What do you do?

Telemedicine allows patients to connect with physicians for evaluation, diagnosis and treatment, using telecommunications technology.

As an important and quickly growing component of health care delivery, many different communities benefit from the use of telemedicine, especially those living in medically underserved areas. Currently, there are about 200 telemedicine networks, with 3,500 service sites in the U.S.

In addition to lower costs, some of the advantages of telemedicine for patients include convenience and privacy. For health care providers, advantages are often reduced cancellations or no-shows, and improved communication with patients, promoting healthy lifestyle choices. TopherTuesdays

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Meet Yayo! Yayo has been a member of the Bates family for ten years. During the holidays, many families welcome a new pet into their home and hearts.

A growing employee benefit, pet insurance provides us an opportunity to ensure all members of our family (even four-legged ones) receive adequate access to the best, and most affordable health care.

In recent years, veterinary costs have risen over 81% consequent of technological advances in X-ray technology, Ultrasound, and MRI’s. What’s more, vet treatment for ongoing conditions can add up to hundreds, if not thousands, of dollars.

Age, breed, species, and location are all factored into the cost of pet insurance. Pricing varies depending on what’s included in the policy, and most insurers offer varying co-pays and deductibles. You can enroll pets any time before their 14th birthday, and can typically find coverage for as low as $16 monthly for cats and $22 monthly for dogs, which covers most accidents and illnesses that are not pre-existing. Additionally, you can choose any licensed vet and you’re reimbursed up to 90% of the bill. TopherTuesdays

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Mental illness and substance abuse are at an all-time high in America. A little-understood and seldom-used employee benefit that can help is an Employer Assistance Program (EAP).

Offered by many employers through health insurance, an EAP is a free and confidential intervention program designed to identify and assist employees in resolving personal or family problems, including: mental health, substance abuse, various addictions, marital problems, parenting problems, emotional problems, or financial or legal concerns.

Despite widespread availability, only 4-6% of people with access to the programs use them. Nonetheless, EAPs can help individuals successfully respond to challenges while reducing healthcare costs associated with stress, depression, and other mental health issues. hashtagTopherTuesdays

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Protecting your future today means understanding how to use insurance as a vehicle to stay healthy and build wealth. A Health Savings Account (HSA) is one way to invest in our own healthcare while leveraging a retirement loophole. Introduced through the Affordable Care Act (ACA), an HSA is a type of high deductible health plan – designed to minimize cost if you don’t utilize medical insurance often. Most useful for qualified expenses, an HSA also provides a triple tax benefit. 1. The money is tax deducible 2. The money grows tax-deferred (interest) 3. You can take it out tax free for qualified expenses For 2018, the IRS maximum contribution for a single individual will be $3,450, and for a family $6,900. Contributions roll over year to year, and if you change employers the account stays with you. When you’re 65, you can use that account for non-medical expenses, but if you do so any earlier, there’s a 20% penalty. Downside to an HSA: If you don’t fund the account, you end up paying for medical expenses from your personal checking or savings accounts with no tax advantages. TopherTuesdays